Here’s the good news from home health agencies in Massachusetts: They manage to find an average of 18 new hires to join the care workforce every three months, according to a recent  report by the Home Care Aide Council.

Here’s the bad news: The same agencies lose an average of 15 home care aides over those three months.

That revolving door puts enormous pressure on agencies to find enough qualified new people to continue serving clients and meet growing demand, according to the report authored by Hayley Gleason, assistant director at the council and a gerontology PhD candidate at UMass Boston’s McCormack Graduate School.

The report found a quarterly staff turnover rate of 16 percent among home care agencies. Nearly 90 percent of agencies said finding enough qualified home care aides was their top workforce challenge. The report identified low pay, lack of benefits, scheduling and training concerns to be among the top issues leading to staff turnover.

“The home care staffing challenge is more serious than ever and could become critical as Massachusetts grows older along with the rest of the country,” said Gleason. “The point of the study was to provide a more detailed understanding of the challenges facing the home care aide workforce in an effort to find solutions through changes to policy and practice.”

Gleason said the combination of very low unemployment and growing demand for services was making staffing challenges especially difficult. “The strong economy makes competition for workers fierce, with home care often losing out,” she said.

The report, supported by the Tufts Health Plan Foundation, was based on one survey of 58 home health agencies and another collected from 656 home care aides. Caitlin Coyle, an assistant adjunct gerontology professor at UMass Boston, and Natalie Shellito, a gerontology PhD student at the university, contributed to the study.

Home care aides in Massachusetts earned $12.77 per hour and worked only 26 hours per week on average, according to the study. More than two of every three aides who responded to the study survey said they were dissatisfied with their pay. Very few receive health insurance through their employer and nearly half obtain coverage via MassHealth.

Aides responding to the survey also said inconsistency of schedules and limited opportunities for training or promotion made their jobs unsustainable. Overall, nearly 40 percent said they intended to leave their jobs as  home care aides in the next year.

“The work of home care aides is critical to the overall health care system, particularly for those who require ongoing support,” said Gleason. “To allow people to age in place, we must have a highly qualified, workforce available to meet the growing demand. Addressing the low wages and limited benefits inherent in these jobs, is critical, as is finding ways to stabilize schedules within the industry, making the job more reliable.”

The council report identified five strategies to reduce pressure on the home care aide workforce and made specific recommendations on how to implement them, including:

Increase recruitment: Identify ways to make initial training inexpensive or free for people interested in a home care career. Improve support for trainees/new workers and work with community-based organizations to recruit younger and non-traditional workers.

 Improve retention: Work with the state legislature to increase wages and improve benefits to home care aides employed by agencies. Invest in programs that support aides to manage personal and work life challenges that threaten their ability to remain on the job.

Stabilize schedules: Develop better ways to cluster clients to improve scheduling and decrease travel. Adopt and reimburse agencies for full-time home care aide positions.

Maximize hours: Engage in a system-wide approach to address benefit cliff issues that force home care aides to limit their hours.

Up-skill and integrate: Invest in new up-skilling opportunities for aides and ensure that state-level funding is designed to support ongoing training, increase information to aides through technology, improve training for supervisors to ensure aides are property supported, partner with managed care entities to build new models for care delivery.